Problem: Substance use is associated with poorer hospital outcomes, increased lengths of stay, higher healthcare costs, and increased mortality. On an adult inpatient medical unit, up to 90% of patients did not receive substance use screening per policy. Implementing the evidence-based model of screenings, brief interventions, and referrals to treatment (SBIRT) in this population would serve to optimize quality of care and patient outcomes. Purpose: To purpose of the QI project was to improve substance use screening and referrals to an Addiction Consult Service (ACS) on an adult Medical Intermediate Care Unit. Methods: This QI project was implemented over a 15-week period on a 16-bed adult medical IMC unit. In order to improve substance use screening in newly admitted patients, staff utilized an existing validated single-item screening question in the electronic medical record. Nursing staff notified the attending physicians for all patients who screened positive; the physician further evaluated the patient and placed an order for the ACS if indicated. Data collection was conducted via manual chart audits; run charts were utilized to track process and outcome measures. Process measures included counts (%) of patients who were screened/assessed for substance use. Outcome measures included counts (%) of patients who screened/assessed as positive and received follow up by a physician and counts (%) of patients who screened positive who were referred to ACS. Results: A total of 53 patients were screened or assessed for substance use. Of these, 100% received a screen or assessment, 49.06% (n=26) were screened by nursing, and 50.94% (n=27) who were missed by nursing received assessments from a physician. Of the patients screened or assessed, 13.21% (n=7) were positive, 11.54% (n=3) of patients screened by nursing were positive and 14.81% (n=4) of the patients missed by nursing but assessed by a physician were positive. Of the patients with positive screenings or assessments, 71.43 (n=5) were referred to the ACS. Conclusion: Implementing nurse-lead substance use screening with a validated screening tool in the electronic medical record is feasible on a busy inpatient medical unit, leads to improved detection rates, improves documentation, and makes screening more convenient.